在晚期慢性心力衰竭中结合心脏再同步和植入式心脏转换除:Miracle ICD试验
James B Young1, William T Abraham, Andrew L Smith
1Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. youngj@ccf.org
JAMA
|May 29, 2003
概括
心脏再同步疗法 (CRT) 结合可植入心脏转动器除器 (ICD) 显著改善了心力衰竭患者的生活质量和运动能力. 综合疗法被证明是安全的,没有增加前节律失常或损害ICD功能.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 心脏衰竭管理的管理
背景情况:
- 使用双心室节奏的心脏再同步疗法 (CRT) 对心力衰竭 (HF) 具有广泛的QRS有效.
- 需要CRT和植入式心脏逆心除器 (ICD) 治疗的患者的结果以前是未知的.
- 这项研究研究了CRT和ICD在重症HF患者的联合疗效和安全性.
研究的目的:
- 评估结合CRT和ICD治疗的疗效和安全性.
- 为了评估纽约心脏协会 (NYHA) 三级或四级充血性心力衰竭患者的结果.
- 为了确定尽管最佳的医疗管理的影响.
主要方法:
- 一个随机,双盲,并行控制的试验,涉及369名患者,LVEF≤35%和QRS持续时间≥130毫秒.
- 尽管得到了最佳的医疗治疗,但患者患心室节律失常和NYHA III/IV 类的风险很高.
- 干预包括CRT (CRT打开,ICD打开) 和对照 (CRT关闭,ICD打开).
主要成果:
- 6个月后,CRT组在生活质量 (P=.02) 和功能类 (P=.007) 中显著改善.
- 峰值氧气消耗 (P=.04) 和跑步机运动持续时间 (P<.001) 随着CRT显著增加.
- 在左心室功能,存活率或住院率上没有观察到显著差异;没有发生前节律失常.
结论:
- 结合CRT和ICD治疗改善了选择的HF患者的生活质量,功能状态和运动能力.
- 随着最佳的医疗管理,在没有对ICD功能或增加前节律失常的不良影响的情况下,获得了改善.
- CRT是管理中度至重度HF的宝贵补充,具有广泛的QRS和高心律失常风险.
相关概念视频
Heart Failure V: Medical Management
641
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
641
Heart Failure VI: Adjunct Therapies
635
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
635
Cardiomyopathy II: Dilated Cardiomyopathy
798
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
798
Cardiomyopathy III: Hypertrophic Cardiomyopathy
810
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
810
Cardiomyopathy IV: Restrictive Cardiomyopathy
957
Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
957
Cardiomyopathy V: Interprofessional Care
761
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
761


